A Randomized, Placebo-Controlled, Double-Blind Study of the Effects of Magnesium Compared to Conventional Therapy on Acute Migraine
ClinicalTrials.gov processed this data on October 2, 2024. Link to the current ClinicalTrials.gov record.Recruitment Status
COMPLETED - HAS RESULTS(See Contacts and Locations)
Verified September 2024 by Wake Forest University Health Sciences
Sponsor
Wake Forest University Health SciencesInformation Provided by (Responsible Party)
Wake Forest University Health SciencesClinicaltrials.gov Identifier
NCT05967442Other Study ID Numbers: AHC-7192-D5000322
First Submitted: January 9, 2020
First Posted: August 1, 2023
Results First Posted: October 1, 2024
Last Update Posted: October 8, 2024
Last Verified: September 2024
History of Changes
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Tracking Information | |
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First Submitted Date | January 9, 2020 |
First Posted Date | August 1, 2023 |
Results First Submitted Date | January 31, 2024 |
Results First Posted Date | October 1, 2024 |
Last Update Posted Date | October 8, 2024 |
Study Start Date | August 23, 2019 |
Actual Primary Completion Date | March 31, 2020 |
Current Primary Outcome Measures(submitted: October 2, 2024) |
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Change History | Complete list of historical versions of study NCT05967442 on ClinicalTrials.gov Archive Site |
Current Secondary Outcome Measures |
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Current Other Outcome Measures | Not Provided |
Descriptive Information | |
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Brief Title | Magnesium Versus Prochlorperazine Versus Metoclopramide for Migraines |
Official Title | A Randomized, Placebo-Controlled, Double-Blind Study of the Effects of Magnesium Compared to Conventional Therapy on Acute Migraine |
Brief Summary | This investigation describes a proposed clinical trial that will evaluate the relative efficacy of intravenous magnesium sulfate for the treatment of migraine compared to intravenous metoclopramide (Reglan) and intravenous prochlorperazine (Compazine) in the treatment of acute headache and migraine in adult patients. The ultimate objective will be clinical application of these drugs in the emergency department for the treatment of acute headache and migraine. The two phenothiazines (metoclopramide and prochlorperazine) have been routinely utilized in the treatment of acute headache and migraine in the emergency department setting. Per the 2017 American Headache Society guidelines, both intravenous metoclopramide and intravenous procholorperazine are recommended as "clinicians should offer" agents with level B evidence. Of note, there are no agents with level A evidence purported by this guideline for acute management of migraine. The same guideline offers "no recommendation can be made regarding the role of intravenous magnesium for adults who present to the ED with acute migraine. However intravenous magnesium may be of benefit to patients who present with migraine with aura." Multiple trials have evaluated intravenous magnesium's safety and efficacy in the management of acute migraine. These have demonstrated the tolerability of intravenous magnesium on a with breadth of patients. Most commonly the primary adverse event was flushing which self-resolved. No cases of hypotension were reported. None of these study agents have been withdrawn from the market. |
Detailed Description | Migraine or severe headache affected one-fifth of women and one-tenth of men in 2015 and is one of the leading causes of disability in the world. Over one million visits to emergency departments (ED) in the US are due to migraines. Migraine, previously believed to be a vascular disorder, is caused by inflammation due to vasodilation in the meninges secondary to the release of vasoactive neuropeptides by stimulation of the trigeminal nerve. This inflammation can result in symptoms such as headache, nausea, vomiting, dizziness, photophobia and phonophobia. Despite migraine being a common disorder, there has yet to be a cure. Several classes of medications have been studied for the treatment of migraine. Recently, conventional therapy has shifted to the use of antidopaminergics including prochlorperazine, metoclopramide and haloperidol, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, and triptans, sumatriptan being the most commonly utilized. 5Although intravenous opioids have historically been the most common treatment for migraines, their use has fallen out of favor due to their association with increased recurrence of headaches and ED visits, abuse potential, and most recently severe intravenous opiate shortage. Alternative treatments include ketamine, propofol, dihydroergotamine and magnesium. Magnesium is an intracellular cation that has been associated with both the function of serotonin and regulation of vascular tone, which are both mechanisms that implicate its role in the treatment of migraine. Intravenous magnesium sulfate has been studied as a treatment for migraine compared to placebo, metoclopramide and prochlorperazine. These studies have shown that magnesium is well-tolerated with a good safety profile and may be efficacious in the treatment of migraine. Metoclopramide, prochlorperazine and magnesium have been recommended in clinical practice guidelines and have become routine standard of care for treatment of migraine in this emergency department. However, no trial has evaluated these modalities simultaneously in the same population. The purpose of our study is to compare the relative efficacy for magnesium, metoclopramide, and prochlorperazine in the treatment of headache and migraine. Via monthly block randomization, patients will be given one of three guideline recommended study drugs. Allocation will be concealed by a pharmacist (not participating in the rest of the study) solely designated to choose which drug will be the assigned study drug for each month. The pharmacists, physicians, and nurses participating in administration of the medications will be blinded to which drug is being administered during each month. Metoclopramide, prochlorperazine and magnesium have been recommended in clinical practice guidelines and have become routine standard of care for treatment of migraine in this emergency department. All three study drugs will be stored in the investigational medication refrigerator located in the main pharmacy. A pharmacist on duty in the emergency department will obtain the medication from the refrigerator and deliver it to the bedside nurse who is actively caring for the patient after an order from the physician. The primary outcome of this study will be mean change in pain from baseline to 30 minutes after initiation of infusion (as defined on a 11-point Numeric Rating Scale. Secondary endpoints include mean change in pain from baseline to 60 minutes and 120 minutes after initiation of infusion (as defined on a 11-point Numeric Rating Scale), time to emergency department discharge, and adverse effects due to administration of study drug (hypotension, flushing, akathisia, dystonia, nausea, vomiting, dizziness, drowsiness, other self-reported adverse effects). |
Study Type | Interventional |
Study Phase | Phase 3 |
Study Design | Allocation: RandomizedInterventional Model: Parallel AssignmentMasking: QuadruplePrimary Purpose: Treatment |
Target Follow-Up Duration | Not Provided |
Biospecimen | Not Provided |
Sampling Method | Not Provided |
Study Population | Not Provided |
Condition |
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Intervention | Drug: Magnesium Sulfate Magnesium Sulfate 2gm in 50ml D5W over 20 minutes |
Study Groups/Cohorts | Experimental: MagnesiumMagnesium Sulfate 2gm in 50ml D5W over 20 minutes Intervention:
Active Comparator: MetoclopramideMetoclopramide 10mg in 50ml D5W over 20 minutes Intervention:
Active Comparator: ProchlorperazineProchlorperazine in 50ml D5W over 20 minutes Intervention:
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Publications * | Not Provided |
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
Recruitment Information | |
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Recruitment Status | Completed |
Actual Enrollment(submitted: October 2, 2024) | 157 |
Actual Study Completion Date | April 6, 2023 |
Actual Primary Study Completion Date | March 31, 2020 |
Eligibility Criteria | Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender | Sexes Eligible for Study: All |
Ages | 18 Years and Older (Adult, Older Adult) |
Accepts Healthy Volunteers | Yes |
Contacts | Contact information is only displayed when the study is recruiting subjects |
Listed Location Countries | United States |
Administrative Information | |
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NCT Number | NCT05967442 |
Other Study ID Numbers | AHC-7192-D5000322 |
Has Data Monitoring Committee | No |
U.S FDA-regulated Product | Studies a U.S. FDA-regulated Drug Product: Yes Studies a U.S. FDA-regulated Device Product: No Product Manufactured in and Exported from the U.S.: Not Provided |
IPD Sharing Statement | Plan to Share IPD: No |
Responsible Party | Wake Forest University Health Sciences, Wake Forest University Health Sciences |
Study Sponsor | Wake Forest University Health Sciences |
Collaborators | Not Provided |
Investigators | Principal Investigator: Michael Cirone, MD, advocate christ medical center |
PRS Account | Wake Forest University Health Sciences |
Verification Date | September 2024 |